A recent audit by the Louisiana Department of Health revealed that one of the dental providers that the state contracts with fell short of expectations, The Black Chronicle reported Aug. 7.
Seven notes:
1. The state health agency had previously only contracted with MCNA Insurance Company since 2014 but added DentaQuest in 2021 to meet federal guidelines that require the state to provide Medicaid beneficiaries with at least two programs to choose from.
2. The state spent approximately $736 million on both of these contracts through Dec. 31, 2023.
3. While the health department was authorized to extend its contract with MCNA for another two years, the state asked the department to conduct a review of DentaQuest's services before renewing its contract for another year.
4. The department paid DentaQuest about $400 million to provide dental coverage to approximately 1.2 million Medicaid members from January 1, 2021, through March 31. However, DentaQuest only provided $232.7 million in dental services during that time.
5. The audit showed that DentaQuest had to refund the health department more than $9 million for not meeting contract requirements to spend at least 85% of its dental coverage allocation on Medicaid users.
6. The audit showed DentaQuest also did not meet all requirements for network adequacy as of June 2023 or June 2024.
7. DentaQuest contracts with five or fewer providers statewide for specialists such as endodontists, periodontists and prosthodontists. It also contracts with zero providers in five of the state's 64 parishes. Forty parishes have zero specialty providers available in DentaQuest's network, according to the audit.
"We are still in the process of reviewing the audit. DentaQuest has had the privilege of serving the state of Louisiana with several dental programs for 11 years and Medicaid and CHIP since 2021," a DentaQuest spokesperson said in a statement to Becker's. "Regarding network adequacy, it is important to note that Louisiana, like other states, faces a provider shortage and all but six parishes are federally designated as dental health professional shortage areas. As responsible stewards of taxpayer dollars, DentaQuest returned $8.1 million to the program amid low utilization in the aftermath of COVID-19. DentaQuest remains committed to serving Louisiana communities and is proud to partner with LDH on our shared goal to increase access to quality care for members, ultimately improving the oral health of all."